Long-term impact of very early exercise after ischaemic stroke on return to work, participation, and quality of life: a one-year follow-up of a randomised controlled trial

Abstract Background Very early exercise (VEE) after stroke has shown short-term benefits on clinical recovery and inflammation; however, its long-term effects on real-world outcomes remain underexplored. This study evaluated whether initiating rehabilitation within 24 h of ischaemic stroke provides sustained benefits in return to work (RTW), work ability (WA), community participation (CP), and health-related quality of life (HRQoL), compared with delayed exercise (DE) at one year post-stroke. Methods In the original randomised controlled trial (Pan African Clinical Trial Registry: PACTR202406755848901), 48 patients with first-ever mild-to-moderate ischaemic stroke were randomised (1:1) to VEE (within 24 h of onset) or DE (after one week), followed by an identical 3-month, 90-min, progressive supervised exercise program. In this one-year observational follow-up, 41 participants (21 VEE; 20 DE) were reassessed on RTW status (full-time or part-time), Work Ability Index (WAI) , social participation domain of the Stroke Impact Scale (SIS), and overall SIS scores. Results At one year, a higher proportion of participants in VEE successfully returned to work, though the difference was not statistically significant (61.9% vs. 40.0%; p = 0.161). VEE participants resumed work significantly earlier (4.96 ± 0.99 vs. 6.50 ± 1.19 months; p = 0.005) and demonstrated significantly higher WAI scores (6.24 ± 2.43 vs. 4.35 ± 2.72; p = 0.024). They also reported greater CP and HRQoL, with significantly higher scores in the SIS social participation domain (62.7 ± 19.8 vs. 48.6 ± 16.5; p = 0.018) and overall SIS scores (65.9 ± 16.9 vs. 55.3 ± 14.5; p = 0.038). Conclusion These findings suggest that VEE may confer meaningful long-term advantages in occupational reintegration, participation, and quality of life. Integrating VEE into stroke rehabilitation protocols could enhance functional recovery and societal reintegration.